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Fetal tolerance requirements may constrain maternal immune response to hookworm, thereby increasing susceptibility to new infections or increasing hemoglobin loss. To explore this possibility, we study systemic immune response and hemoglobin levels in a natural fertility population with endemic helminthic infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used Bayesian multilevel models to analyze mixed longitudinal data on hemoglobin, hookworm infection, reproductive state, eosinophils, and erythrocyte sedimentation rate (ESR) to examine the effects of pregnancy and hookworm infection on nonspecific inflammation, cellular parasite response, and hemoglobin among 612 Tsimane women aged 15\u201045 (1016 observations).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Pregnancy is associated with lower eosinophil counts and lower eosinophil response to hookworm, particularly during the second and third trimesters. Both hookworm and pregnancy are associated with higher ESR, with evidence for an interaction between the two causing further increases in the first trimester. Pregnancy is moderately associated with higher odds of hookworm infection (OR: 1.23, 95% CI: 0.83 to 1.83). Pregnancy and hookworm both decrease hemoglobin and may interact to accentuate this effect in the first\u2010trimester of pregnancy (Interaction: \u03b2: \u22120.30\u2009g\/dL; CI: \u22120.870 to 0.24).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings are consistent with a possible trade\u2010off between hookworm immunity and successful pregnancy, and with the suggestion that hookworm and pregnancy may have synergistic effects, particularly in the first trimester.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ajhb.23337","type":"journal-article","created":{"date-parts":[[2019,10,23]],"date-time":"2019-10-23T09:30:03Z","timestamp":1571823003000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Old friends and friendly fire: Pregnancy, hookworm infection, and anemia among tropical horticulturalists"],"prefix":"10.1002","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9204-9076","authenticated-orcid":false,"given":"Amy S.","family":"Anderson","sequence":"first","affiliation":[{"name":"Department of Anthropology University of California Santa Barbara  California Santa Barbara"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin C.","family":"Trumble","sequence":"additional","affiliation":[{"name":"School of Human Evolution and Social Change, Center for Evolution and Medicine Arizona State University  Tempe Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Hov\u00e9","sequence":"additional","affiliation":[{"name":"Department of Anthropology University of California Santa Barbara  California Santa Barbara"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas S.","family":"Kraft","sequence":"additional","affiliation":[{"name":"Department of Anthropology University of California Santa Barbara  California Santa Barbara"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hillard","family":"Kaplan","sequence":"additional","affiliation":[{"name":"Economic Science Institute Chapman University  Orange California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Gurven","sequence":"additional","affiliation":[{"name":"Department of Anthropology University of California Santa Barbara  California Santa Barbara"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5871-9865","authenticated-orcid":false,"given":"Aaron D.","family":"Blackwell","sequence":"additional","affiliation":[{"name":"Department of Anthropology University of California Santa Barbara  California Santa Barbara"},{"name":"Department of Anthropology Washington State University  Pullman Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,10,23]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2010.02598.x"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2011.10-0189"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0102-311X1988000200006"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.2147\/IJWH.S103529"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0001218"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1098\/rspb.2013.1671"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.aac7902"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.aac7902"},{"key":"e_1_2_9_10_1","unstructured":"Blackwell A. 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